Cornell McCullom III, D.D.S., M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

021001488 Issued in IL

Practice address

820 E 87TH St
Ste. 201
Chicago, IL 60619-6253

Phone

(773) 488-3738

Fax

(773) 874-6575

NPI assigned

Aug 19, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219104000000",
    "number": "1619124807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 E 87TH ST",
            "address_2": "STE. 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606196253",
            "telephone_number": "773-488-3738",
            "fax_number": "773-874-6575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E 87TH ST",
            "address_2": "STE. 201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606196253",
            "telephone_number": "773-488-3738",
            "fax_number": "773-874-6575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOM",
        "first_name": "CORNELL",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.D.S., M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-19",
        "last_updated": "2008-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021001488",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emery Harris McCrory
• Katherine S McCrossen
• Adam J McCue, AGACNP-BC
• Cassidy Shay McCue
• Doris Jean McCulley, M.D.,M.B.A.
• Noelle Galiber McCullom, DDS
• Yetta G McCullom, DDS, MA
• Imari C McCullough
• Kristin M McCullough, DDS
• Lindsay McCullough, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Chicago, IL
• Providers in Chicago, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.